Orthopedic appliance



June 10, 1952 H, s, SILVERMAN ETA; 2,599,589

ORTHOPEDIC APPLIANCE Filed July 25, 1949 2 SHEETS-SHEET l .2. 8 g gigs: m. 5. 4\ LO 8 of /l 2W o o Immunhmunmuuunuulmumnnnqlmullmluud 5 J1 c: J9

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N V EN TOR. Henry S Silverman, Stanley MRdfer 8:

BY Earnest Obzrhem faim June 10, 1952 H. s. slLvERMAN ErAL 2,599,589

oRTHoPEDIc APPLIANCE Filed July 25, 1949 2 SHEETS-SHEET 2 1N V EN TOR. Henry S, Silverman, Stanley M.Raffer&

BY Earnest FOberheg'm Patented June l10, 1952 ORTHOPEDIC APPLIANCE Henry S. Silverman, Stanley M. Raffer and Earnest F. Oberheim, Pittsburgh, Pa.; said Raier and said Oberheim assignors to said Silverman Application July 25, 1949, Serial No. 106,718V

(Cl. Sii- 71) 7 Claims. l

This invention" relates generally, to orthopedic 2lppliances and more in particular to such` applianoes aiording a degree of adjustability within predetermined. limits of position.

Deformities and` disabilities of the foot prevent its. proper function as a means of locomotion and in this respect frequently impose serious ambulatory limitations. upon` an individual, as well as inducing other harmful effects the lower extremities and central nervous system and genoljal health.` The development` of various appliancesfor supplying support to various regions of the foot has aiorded adegree of mechanical correction for many common disabilities of the foot.

In most instances, the mentioned4 appliances are inthe form of pads contoured in cross-section` to aiiord a predetermined elevation to a particular section of the foot and located laterally and longitudinally of the foot, in the shoe to eifect the desired elevation at a predetermined point. ln4 practice, once the proper diagnosis oi the disability is made, the pad is usually permanently xed within the shoe, or permanently fixed to a memberfsuch as an insole, insertable into the shoe.

This practice, however, presents several practical problems primarily due to the resilient properties ofthe foot. Importantly among these is the accurate determination of the position occupiedbyA the foot within the shoe. While it is true that means are available for measuring certain dimensions, the flexibility of the foot substantiallyV rules out the possibility of measurement to that degree of accuracy that a correction frequently requires. Thus a correct diagnosis and a properlyI designed lift or pad will benefit the foot condition little and may further aggravate the condition if the pad is improperly placed. Trial and error methods are usually the rule and are costly in time and in money, because of the extensive alterations required to effect a minor readjustment of the pad.

Yet another important consideration is the physical change occurring in the foot as a result of varying degrees of activity and fatigue. Swelling of the foot and muscular relaxation are common causes of a shift in the required position of a pressure point which, with a permanently located support, is not obtainable. It is appreciated that such a change may be small indeed. However, the mechanics of the foot is such that a slight increment of dimensional change in hearing, points can produce a substantial degree f dSQOmfort.

A pad or support conveniently adjustable in directions longitudinally and transversely of the foot offers a solution to the general problem, noted only in part hereinabove, but at the same time presents certain problems which, if improperly treated, may defeat the purpose of the adjustable support. A few of the more salient considerations are noted below.

The contouri-ng of the pad or support is equally as important as its properA placing. Hence, any adjustable device employed in attaching the pad within the shoe or to a member insertable into the shoe must not distort the pad and should function within limi-ts to support the pad and minimize unwanted. deflection.

The adjustable device should aiord a suicient margin of adjustment transversely and longitudinally of the foot to be practical in its application.

Additionally the mechanical movement must be of a type which is as thin as practical considerations permit and which is yet positive in operation throughout the range of movements.

In keeping with the foregoing considerations, it is one object of this invention to provide an adjustable orthopedic appliance which is simple in its elements and positive in operation.

It is another object of this invention to provide an adjustable orthopedic appliance having two degrees of freedom.

Still another object of this invention is to` provide an orthopedic appliance of the character referred to which is self-locking in any selected position within its practical limits of motion.

A further object of this invention is to provide an orthopedic device which is adjustable, in which the adjustable mechanical means is sufliciently thin so as to` be imperceptible under the pad or support.

Yet a further object of this invention is to provide an adjustable orthopedic appliance affording predetermined increments of adjustment wherein the adjusting mechanism is designed to produce audible clicks with each incremental movement indicating the extent of movement by the number of clicks.

The foregoing statements are merely illustrative of the various aims and objects of this invention. Other objects and advantages will become apparent upon a study ofv the following specification when considered in conjunction with the accompanying drawings, in which:

Fig. l is an enlarged assembly view in plan form of an `adjustable structure, for use in orthopedic appliances, embodying the principles of this invention.

Figs. 2, 3 and 4 are details of the components of the assembly of Fig. 1.

Figs. 5 and 6, are respectively, end views of the elements or components illustrated in Figs. 2 and 4.

Fig. '7 is a sectional View taken on the line VII-VII of Fig. 3.

Fig. 8 is a perspective View of the part shown in Fig. 3.

Fig. 9 is a fragmentary plan view of an insole illustrating an embossing detail therein,

Fig. 1() illustrates the insole of Fig. 9, showing the mounting of the adjustable structure in the embossed section Fig. ll illustrates a metatarsal pad in bottomplan showing the associated structural component mounted on the bottom thereof.

Fig. 12 illustrates an assembly of an orthopedic appliance according to the principles of this invention, embodying two types of lifts on one insole.

Fig. 13 is a sectional View taken on the line KEI-X111 of Fig. 12, and Y Figs. 14, 15 and 16 each show plan views of other variations of this invention. v

As earlier noted herein, an orthopedic appliance for adjustably positioning such items as longitudinal arch supports, metatarsal pads, cuboid pads, etc., must provide two degrees of freedom, one transversely of the foot and one longitudinally. The extent of movement in each direction depends upon the requirements. Elementary considerations indicate a larger longitudinal adjustment than a transverse adjustment for the longitudinal arch support. Whereas, in the application of adjustability to a metatarsal pad, the transverse adjustment to cover the span of the second to fourth metatarsal shafts is preferably the larger.

An apparatus which accomplishes the above functional requirements and which represents a preferred embodiment of this invention is illustrated in assembly form in Fig. 1 and its details in Figs. 2 through 8. The apparatus includes a top plate l and a bottom plate 2 formed of thin resilient sheet material, preferably metal, which are supported and guided for linear movement in directions displaced by 90 by means of a guide plate 3. Guide plate 3 is formed of a single piece of resilient sheet material to denne narrow plate receiving guides or channels along the opposite edges thereof. To this end the guide plate is blanked from suitable sheet material with notched corners and thereafter the two pairs of parallel plate edges are bent through 180 in opposite directions, one pair up and one pair down as viewed, to define the pair of guides or channels 3 and the pair of bottom guides or channels 5 in which the confronting faces of the channel sides of the respective pairs are spaced a `sufficient distance to clear the thickness of the top and bottom plates, respectively.

The fit of the top and bottom plates l and 2 through the associated guides must be neat to avoid unnecessary relative movement between the top and bottom plates and the guide plate which may result in disturbing audible sounds and additionally to provide a degree of frictional restraint'which tends to stabilize the assembly in predetermined fixed positions. Since it is not feasible to form the guides with parallel faces spaced with the degree of accuracy required to meet this condition and further since the thickness of the top and bottom plates is not constant it is preferred to form the bight of the channel guides to a dimension somewhat greater than the top and bottom plate thicknesses and to roll the edges toward the guide plate surface in the required amount so that the top and bottom plates are gripped between the guide plate surface and the edges of the channel guides. Thus as will be appreciated from an inspection of Fig. 7, a cantilever spring bias is utilized to provide the required degree of frictional restraint and the engagement is sufficiently soft that the frictional restraint is substantially uniform. The Width ofthe top and bottom plates should correspond closely, on the small side, to the width between the bights of the pairs of channels to minimize appreciable angular displacement of the top and bottom plates from the position indicated. Otherwise objectionable angular movement of the pad or support may occur.

With the assembly thus far described it will be appreciated that if the bottom plate is stationarily secured the top plate may be moved longitudinally and laterally thereof. For move- -ment longitudinally of the bottom plate the top plate and guide plate move as a unit along the bottom plate, the edges of which slide through the channel guides 5. For movement of the top plate in a lateral direction the edges of the top plate slide through the channel guides 4, thus affording two degrees of freedom of movement of the top plate with respect to the bottom plate.

For the instant application, however, friction restraint alone is uncertain and may permit shifting of the mechanism from a predetermined position under impact as occurs upon contact of the foot with the ground and the transfer of the body load from the heel to the toes. A conveniently adjusted self locking arrangement is therefore indicated. Such an arrangement is preferably operable without tools and at the same time should also preferably indicate the degree of movement which has been effected. This indication may be obtained by suitable reference markings. But since the device affords two degrees of freedom, such a reference marking would likely be only of the form of a point sufficiently displaced that it would never be covered by the top plate, or an attachment thereto, when moved to an extreme diagonal position.

A system which produces audible clicks, each click indicating a predetermined distance, affords an indication of distance from an arbitrary starting point. By the simple expedient of noting the number of clicks in each direction of movement from the starting point back tracking of 4the mechanism to the starting point is obtainable.

An arrangement combining the locking feature with an audible means of measurement is embodied in the device of Figs. 1 through 9, wherein each plate is stamped with a row of teeth 'e' and 8, respectively, down the longitudinal centerline thereof. The faces of the teeth are disposed approximately at an angle of 45 to the I,plate surface although a lesser angle may be employed if less positive locking is desired. Conical projections 9 extended upwardly from the guide plate 3 engage the teeth 'l and conical projections Il) extended downwardly from guide plate 3 engage the teeth 8. Thus the plates may be moved a tooth at a time with respect to the guide plate by the function of the projecting inter-jacent mating portions of the assembly and in effect locked in any selected position. Positive engagement of the teeth with the projections is assured, even under twisting of the assembly, by curving the top and bottom plates as shown i-n Figs.` 6 and 5, respectively, so that a spring bias of the teeth in a direction to` engage the projections is obtained.

The stages of assembly of the adjustable orthopedic appliance are illustrated in Figs. 9 through 12` having primary reference to an adjustable metatarsal pad which is to be assembled on an insole insertable into a shoe; The insole I5 is embossed at I l` over an area sulicient tol receive the bottom plate 2. Deeper embossed grooves l1 are provided along two opposite sides of the embossed section to clear the channel guides 5 and? the embossing is carried to a depth corresponding to the dimension from the bottom side of the bottom plate to the bottomside of the top plate so that upon placing of the assembly into the embossed area with the bottom plate bearing on the bottom of the embossed area, the bottom side of the top plate lies flush with the upper surface of the insole to glide thereover. The positioning of the bottom plate with the guide plate thereon in the embossed area appears in Fig. 10, wherein the assembly is secured to the insole by means of rivets I3. More or less rivets than those illustrated may be employed as required and other suitable fastening means, including gluing, are contemplated. The outline of the metatarsal pad in a substantially central position over the assembly is shown in dot-dash lines.

In Fig. 1l the top plate I is attached to the metatarsal pad I9 by rivets 2G. This pad is then positioned beside the bottom plate and guide vplate assembly and one end of top plat-e I inserted into the channel guides 4 and notched into the desired transverse position. Thereafter the required longitudinal setting is made and the assembly is ready for insertion into the shoe. The pad is made of suliicient area to cover the adjustable mechanism over the required range of adjustment. If made of leather the pad may be sized to provide a suitable degree of stiffness. Careful skiving is indicated to feather the pad edges to obviate discomfort from this source and the pad may be finished with a suitable `thin leather covering to present a finished surface. Alternatively the entire insole and pad may be covered with a thin finishing leather or other suitable material, care being exercised to avoid gluing of the finishing leather or material to the pad or to the area of adjustment of the pad. In this application the pad may be formed of a material capable of having a highly finished surface and having a low coefficient of friction with leather or other material to slide over the leather with ease and facilitate adjustment. The pad is then adjusted by applying forces thereto through the finish leather. The leather finish may also be applied with an adhesive which does not set, so that it may be lifted in the pad region for the purpose of pad adjustment. In this latter case the adhesive may also be applied to the leather over the pads area to further stabilize the pad once the adjustment is made.

The orientation of the adjusting assembly on the insole is primarily a matter of choice, but it is preferred to tilt the assembly at an angle to the longitudinal line of the insole so that the longitudinal axis of the guide plate substantially parallels the anterior extremities of the metatarsal shafts. This arrangement minimizes longitudinal adjustments when the primary adjustments are between the medial and lateral sides of the foot.

The completed metatarsal pad assembly is lndicated in Fig. 112 at a reduced scale. This figure also illustrates an adjustable longitudinal arch support 25. vThe adjustable mechanism is again positioned inan` embossed area similar to that of the metatarsal pad assembly as shown in the enlarged section of Fig. 13'. In this application the bottom plate lies transversely of the insole and the top plate is fastened to the longitudinal arch support. This support may be of any suitable material, aleather support being shown which is supported above an impregnated frabric form presenting a suitable bottom face for attachment of the plate I. For the design proportions shown, a larger longitudinal movement than a transverse movement is provided. Various combinations of these supports with cuboids and others may be obtained, or single units employed as dictated by requirements.

It will be appreciated that this adjustable orthopedic appliance may also be incorporated as a. permanent installation in a shoe during manufacture. Since the device is adjustable,`

positioning to prescription is obviated and since the pad or support is removable, the degree of elevation and contour may be decided during fitting and insertedA at that time.

The modication of this invention `appearing in Fig. 14 differs only in the plan form of the top plate la. This plate is now curved as an are of a circleA in plan form to follow an arcuate path through the guides 4. An examination of the structure of the foot indicates that the anterior extremities of the metatarsal shafts do not deline a straight line, but rather a curve approximating an arc. By positioning this assembly as shown in Fig. 10, longitudinal adjustments are further minimized when lateral adjustments are made. Although top plate I is curved it is not necessary to curve the guides 4 in the same direction if the guide spacing is made sufficient to clear the width of the curved plate.

The parallelogram design of Fig. l5 permits paralleling of the longitudinal axis of the bottom plate 2 with the longitudinal line of the insole for metatarsal applications, while the linear movement of the .top plate substantially parallels the required direction of the metatarsal adjustment.

In Fig. 16 the toothed sections of the top and bottom plates are placed beneath the guides which are correspondingly grooved. Greater spring pressure for locking the plates results from this construction.

The foregoing disclosure and the showing made in the drawings are merely illustrative of the principles of this invention and are not to be construed in a limiting sense.

We claim as our invention:

l. An adjustable metatarsal support comprising, in combination, a sole member, a metatarsal pad, a guide plate of resilient sheet material of the shape of a parallelogram, a set of channel guides on one side of said guide plate adjacent parallel edges and having the open sides of the channels in confronting relation, a set of channel guides on the other side of said guide plate adjacent the remaining parallel edges and having the open sides of the channels facing each other, a plate having one pair of parallel edges fitted through each set of channel guides to slide back and forth therethrough, intermeshing teeth between each plate and said guide plate, means securing one plate to said sole member forward of the shank portion thereof and rearward of 7 the Widest portion thereof, and means securing said pad to the other of said plates.

2. An adjustable foot supporting appliance comprising, in combination, a sole member, a pad of a configuration to lift a predetermined portion of the foot, a first plate of resilient material secured to said sole member in the region of the sole member beneath said predetermined portion of the foot when the foot is positioned over said sole member, a guide plate slidably mounted on said first plate, and a second plate of resilient material secured to said-pad and slidably mounted on said guide plate at an angle to said first at plate.

3. An adjustable foot supporting appliance comprising, in combination, a sole member, a pad of a configuration to lift a predetermined portion of the foot, a rst flat plate of a flexible material secured to said sole member in the region of the sole member substantially beneath said predetermined portion of the foot when the foot is positioned over said sole member, a guide plate of the configuration of a parallelogram having a pair of parallel channel-shaped edges on one face thereof and a second pair of channel-shaped parallel edges on the opposite face thereof, said channel shaped edges defining the margins of said guide plate and the channels of the respective pairs opening towards one another, one pair of channel shaped edges being slidably fitted over said first flat plate, affording sliding movement of said guide plate along said first plate, and a second flat plate of resilient material secured to said pad, said second fiat plate being slidably fitted through the remaining pair of channel shaped edges.

4. An adjustable rnetatarsal support comprising, in combination, a sole member, a metatarsal pad, a first plate secured to said sole member forward of the shank portion thereof and to the rear of the widest portion thereof, guide means slidably engaging said first plate for movement therealong, and a second plate secured to said pad and slidably engaged with said guide means for movement in a direction at an angle to said rst plate.

5. An adjustable metatarsal support comprising, in combination, a sole member, a metatarsal pad, a guide plate of the configuration of a `parallelogram having a pair of opposite channel shaped edgeson one side thereof and a second pair of opposite channel shaped edges on the opposite side thereof, said pairs of channel shaped edges defining the respective pairs of parallel edges of said guide plate, a rst plate slidably fitted through the iirst mentioned pair of channel shaped edges, a second plate slidably fitted through the second pair of channel shaped edges, means securing the first plate to said sole member forward of the shank portion thereof and rearward of the widest portion thereof, means securing said second plate to said pad, a covering having the shape of the sole member, said covering being fitted over said sole member, and being cemented thereto at the rear portion thereof.

6. In an adjustable longitudinal arch support, the combination of, a sole member, a longitudinal arch support pad, a rst plate secured to said sole member in the region of the shank thereof, guide means slidably engaged with said first plate to slide therealong, and a second plate secured to said pad and slidably engaged with said guide means at an angle to said rst plate.

7. In an adjustable cuboid support, the combination of, a sole member, a cuboid pad, a rst plate secured to said sole member in the region of the shank thereof, guide means slidably engaged with said first plate to slide therealong, and a second plate secured to said pad and slidably engaged with said guide means at an angle to said first plate.

HENRY S. SILVERMAN. STANLEY M. RAFFER. EARNEST F. OBERHEM.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS Number Name Date 1,374,418 Becker Apr. 12, 1921 1,391,714 Blake Sept. 27, 1921 1,589,877 Foley June 22, 1926 1,668,229 Calvo May l, 1928 1,952,613 Silver Mar. 27, 1934 1,981,920 Lelyveld Nov. 27, 1934 2,446,448 Whitman Aug. 3, 1948 

